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GYN-Ovary.html
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<title>Ovary, fallopian tube and peritoneum cancers</title>
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<div class="form_description">
<h2><a href=".\cap\Cancer-Protocols-2024-06-Update\Gynecologic Protocol Folder\Ovary_FT_Perit_1.5.0.0.REL_CAPCP.pdf" target="_blank">
<div class="tooltip">Primary tumors of the ovary, fallopian tube and peritoneum
<span class="tooltiptext">click to access explanations in the original CAP template</span>
</div>
</a></h2>
</div>
<form>
<!--
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Gross descriptions:</label></legend>
<p><label class="description">- Procedure:</label>
<input class="element checkbox" type="checkbox" id="A01" value=" - Total hysterectomy and bilateral salpingo-oophorectomy"><label>Total hysterectomy and bilateral salpingo-oophorectomy</label><br>
<input class="element checkbox" type="checkbox" id="A02" value=" - Radical hysterectomy"><label>Radical hysterectomy</label><br>
<input class="element checkbox" type="checkbox" id="A03" value=" - Simple hysterectomy"><label>Simple hysterectomy</label><br>
<input class="element checkbox" type="checkbox" id="A04" value=" - Supracervical hysterectomy"><label>Supracervical hysterectomy</label><br>
<input class="element checkbox" type="checkbox" id="A05" value=" - Bilateral salpingo-oophorectomy"><label>Bilateral salpingo-oophorectomy</label><br>
<input class="element checkbox" type="checkbox" id="A06" value=" - Right salpingo-oophorectomy"><label>Right salpingo-oophorectomy</label><br>
<input class="element checkbox" type="checkbox" id="A07" value=" - Left salpingo-oophorectomy"><label>Left salpingo-oophorectomy</label><br>
<input class="element checkbox" type="checkbox" id="A08" value=" - Salpingo-oophorectomy, side not specified"><label>Salpingo-oophorectomy, side not specified</label><br>
<input class="element checkbox" type="checkbox" id="A09" value=" - Right oophorectomy"><label>Right oophorectomy</label><br>
<input class="element checkbox" type="checkbox" id="A10" value=" - Left oophorectomy"><label>Left oophorectomy</label><br>
<input class="element checkbox" type="checkbox" id="A11" value=" - Oophorectomy, side not specified"><label>Oophorectomy, side not specified</label><br>
<input class="element checkbox" type="checkbox" id="A12" value=" - Bilateral salpingectomy"><label>Bilateral salpingectomy</label><br>
<input class="element checkbox" type="checkbox" id="A13" value=" - Right salpingectomy"><label>Right salpingectomy</label><br>
<input class="element checkbox" type="checkbox" id="A14" value=" - Left salpingectomy"><label>Left salpingectomy</label><br>
<input class="element checkbox" type="checkbox" id="A15" value=" - Salpingectomy, side not specified"><label>Salpingectomy, side not specified</label><br>
<input class="element checkbox" type="checkbox" id="A16" value=" - Omentectomy"><label>Omentectomy</label><br>
<input class="element checkbox" type="checkbox" id="A17" value=" - Peritoneal biopsies"><label>Peritoneal biopsies</label><br>
<input class="element checkbox" type="checkbox" id="A18" value=" - Peritoneal tumor debulking"><label>Peritoneal tumor debulking</label><br>
<input class="element checkbox" type="checkbox" id="A19" value=" - Peritoneal washing"><label>Peritoneal washing</label><br>
<input class="element checkbox" type="checkbox" id="A20" value=" - Pleurocentesis (pleural fluid)"><label>Pleurocentesis (pleural fluid)</label><br>
<input class="element checkbox" type="checkbox" id="A21" value=" - Other (specify):"><label>Other (specify):</label><br>
</p>
<p>
<label class="description">- Hysterectomy type:</label>
<select class="element select medium" ID="A22">
<option value=""></option>
<option value=" - Abdominal">Abdominal</option>
<option value=" - Vaginal">Vaginal</option>
<option value=" - Vaginal, laparoscopic-assisted">Vaginal, laparoscopic-assisted</option>
<option value=" - Laparoscopic">Laparoscopic</option>
<option value=" - Laparoscopic, robotic-assisted">Laparoscopic, robotic-assisted</option>
<option value=" - Other (specify):">Other (specify):</option>
<option value=" - Not specified">Not specified</option>
</select>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Specimen integrity:</label></legend>
<p>
<label class="description">- Specimen integrity, right ovary:</label>
<select class="element select medium" ID="A23">
<option value=""></option>
<option value=" - Capsule intact">Capsule intact</option>
<option value=" - Capsule ruptured">Capsule ruptured</option>
<option value=" - Fragmented">Fragmented</option>
<option value=" - Other (specify):">Other (specify):</option>
</select>
</p>
<p>
<label class="description">- Specimen integrity, left ovary:</label>
<select class="element select medium" ID="A24">
<option value=""></option>
<option value=" - Capsule intact">Capsule intact</option>
<option value=" - Capsule ruptured">Capsule ruptured</option>
<option value=" - Fragmented">Fragmented</option>
<option value=" - Other (specify):">Other (specify):</option>
</select>
</p>
<p>
<label class="description">- Specimen integrity, right fallopian tube:</label>
<select class="element select medium" ID="A25">
<option value=""></option>
<option value=" - Serosa intact">Serosa intact</option>
<option value=" - Serosa ruptured">Serosa ruptured</option>
<option value=" - Fragmented">Fragmented</option>
<option value=" - Other (specify):">Other (specify):</option>
</select>
</p>
<p>
<label class="description">- Specimen integrity, left fallopian tube:</label>
<select class="element select medium" ID="A26">
<option value=""></option>
<option value=" - Serosa intact">Serosa intact</option>
<option value=" - Serosa ruptured">Serosa ruptured</option>
<option value=" - Fragmented">Fragmented</option>
<option value=" - Other (specify):">Other (specify):</option>
</select>
</p>
<p>
<label class="description">- Morcellated specimen (specify organ):</label>
<input type="text" ID="A27" class="element text medium" ></p>
<br>
</fieldset></p>
<p><label class="description">- Tumor site:</label>
<input class="element checkbox" type="checkbox" id="A28" value=" - Right ovary"><label>Right ovary</label><br>
<input class="element checkbox" type="checkbox" id="A29" value=" - Left ovary"><label>Left ovary</label><br>
<input class="element checkbox" type="checkbox" id="A30" value=" - Bilateral ovaries"><label>Bilateral ovaries</label><br>
<input class="element checkbox" type="checkbox" id="A31" value=" - Ovary, laterality cannot be determined (explain):"><label>Ovary, laterality cannot be determined (explain):</label><br>
<input class="element checkbox" type="checkbox" id="A32" value=" - Right fallopian tube"><label>Right fallopian tube</label><br>
<input class="element checkbox" type="checkbox" id="A33" value=" - Left fallopian tube"><label>Left fallopian tube</label><br>
<input class="element checkbox" type="checkbox" id="A34" value=" - Fallopian tube, laterality cannot be determined (explain):"><label>Fallopian tube, laterality cannot be determined (explain):</label><br>
<input class="element checkbox" type="checkbox" id="A35" value=" - Right tubo-ovarian"><label>Right tubo-ovarian</label><br>
<input class="element checkbox" type="checkbox" id="A36" value=" - Left tubo-ovarian"><label>Left tubo-ovarian</label><br>
<input class="element checkbox" type="checkbox" id="A37" value=" - Bilateral tubo-ovarian"><label>Bilateral tubo-ovarian</label><br>
<input class="element checkbox" type="checkbox" id="A38" value=" - Tubo-ovarian, laterality cannot be determined (explain):"><label>Tubo-ovarian, laterality cannot be determined (explain):</label><br>
<input class="element checkbox" type="checkbox" id="A39" value=" - Primary peritoneum"><label>Primary peritoneum</label><br>
<input class="element checkbox" type="checkbox" id="A40" value=" - Other (specify):"><label>Other (specify):</label><br>
</p>
<p>
<label class="description">- Ovarian surface involvement:</label>
<select class="element select medium" ID="A41">
<option value=""></option>
<option value=" - Not identified">Not identified</option>
<option value=" - Present, specify laterality:">Present, specify laterality:</option>
<option value=" - Cannot be determined (explain):">Cannot be determined (explain):</option>
</select>
</p>
<p>
<label class="description">- Fallopian tube surface involvement:</label>
<select class="element select medium" ID="A42">
<option value=""></option>
<option value=" - Not identified">Not identified</option>
<option value=" - Present, specify laterality:">Present, specify laterality:</option>
<option value=" - Cannot be determined (explain):">Cannot be determined (explain):</option>
</select>
</p>
<p>
<label class="description">- Tumor size:</label>
<select class="element select medium" ID="A43">
<option value=""></option>
<option value=" - Greatest dimension (mm): ">Greatest dimension (mm): </option>
<option value=" - All dimensions (mm x mm x mm): ">All dimensions (mm x mm x mm):</option>
<option value=" - Cannot be determined (explain): ">Cannot be determined (explain):</option>
</select>
</p>
<br>
</fieldset>
</p>
-->
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Microscopic descriptions:</label></legend>
<p>
<label class="description">- Tumor histology and immunohistochemical studies: </label>
<textarea ID="A44" class="element textarea medium"></textarea>
</p>
<p>
<label class="description">- <a href=".\cap\Cancer-Protocols-2024-06-Update\Gynecologic Protocol Folder\Ovary_FT_Perit_1.5.0.0.REL_CAPCP.pdf#page=22" target="_blank">Histologic type</a>:</label>
<input class="element checkbox" type="checkbox" id="A46" value=" - Serous borderline tumor"><label class="choice">Serous borderline tumor</label>
<input class="element checkbox" type="checkbox" id="A166" value=" - Serous borderline tumor, micropapillary / cribriform variant"><label class="choice">Serous borderline tumor, micropapillary / cribriform variant</label>
<input class="element checkbox" type="checkbox" id="A47" value=" - Serous borderline tumor with microinvasion"><label class="choice">Serous borderline tumor with microinvasion</label>
<input class="element checkbox" type="checkbox" id="A48" value=" - Microinvasive low-grade serous carcinoma"><label class="choice">Microinvasive low-grade serous carcinomaa</label>
<input class="element checkbox" type="checkbox" id="A49" value=" - Low-grade Serous carcinoma"><label class="choice">Low-grade Serous carcinoma</label>
<input class="element checkbox" type="checkbox" id="A136" value=" - High-grade Serous carcinoma"><label class="choice">High-grade Serous carcinoma</label>
<input class="element checkbox" type="checkbox" id="A55" value=" - Mucinous borderline tumor"><label class="choice">Mucinous borderline tumor</label>
<input class="element checkbox" type="checkbox" id="A56" value=" - Mucinous borderline tumor with intraepithelial carcinoma"><label class="choice">Mucinous borderline tumor with intraepithelial carcinoma</label>
<input class="element checkbox" type="checkbox" id="A57" value=" - Mucinous borderline tumor with microinvasion"><label class="choice">Mucinous borderline tumor with microinvasion</label>
<input class="element checkbox" type="checkbox" id="A58" value=" - Mucinous adenocarcinoma"><label class="choice">Mucinous adenocarcinoma</label>
<input class="element checkbox" type="checkbox" id="A50" value=" - Endometrioid borderline tumor"><label class="choice">Endometrioid borderline tumor</label>
<input class="element checkbox" type="checkbox" id="A52" value=" - Endometrioid carcinoma"><label class="choice">Endometrioid carcinoma</label>
<input class="element checkbox" type="checkbox" id="A137" value=" - Endometrioid carcinoma. seromucinous type"><label class="choice">Endometrioid carcinoma, seromucinous type</label>
<input class="element checkbox" type="checkbox" id="A61" value=" - Seromucinous borderline tumor"><label class="choice">Seromucinous borderline tumor</label>
<input class="element checkbox" type="checkbox" id="A53" value=" - Clear cell borderline tumor"><label class="choice">Clear cell borderline tumor</label>
<input class="element checkbox" type="checkbox" id="A54" value=" - Clear cell carcinoma"><label class="choice">Clear cell carcinoma</label>
<input class="element checkbox" type="checkbox" id="A64" value=" - Borderline Brenner tumor"><label class="choice">Borderline Brenner tumor</label>
<input class="element checkbox" type="checkbox" id="A65" value=" - Malignnat Brenner tumor"><label class="choice">Malignant Brenner tumor, malignant</label>
<input class="element checkbox" type="checkbox" id="A138" value=" - Mesonephric-like adenocarcinoma"><label class="choice">Mesonephric-like adenocarcinoma</label>
<input class="element checkbox" type="checkbox" id="A71" value=" - Small cell carcinoma, hypercalcemic type"><label class="choice">Small cell carcinoma, hypercalcemic type</label>
<input class="element checkbox" type="checkbox" id="A139" value=" - Dedifferentiated carcinoma"><label class="choice">Dedifferentiated carcinomae</label>
<input class="element checkbox" type="checkbox" id="A74" value=" - Undifferentiated carcinoma, NOS"><label class="choice">Undifferentiated carcinoma, NOS</label>
<input class="element checkbox" type="checkbox" id="A69" value=" - Carcinosarcoma (malignant mixed Mullerian tumor)"><label class="choice">Carcinosarcoma (malignant mixed Mullerian tumor)</label>
<input class="element checkbox" type="checkbox" id="A66" value=" - Carcinoma, subtype cannot be determined"><label class="choice">Carcinoma, subtype cannot be determined</label>
<input class="element checkbox" type="checkbox" id="A67" value=" - Mixed epithelial borderline tumor (specify types and percentages):"><label class="choice">Mixed epithelial borderline tumor (specify types and percentages):</label>
<input class="element checkbox" type="checkbox" id="A68" value=" - Mixed carcinoma (specify types and percentages):"><label class="choice">Mixed carcinoma (specify types and percentages):</label>
<input class="element checkbox" type="checkbox" id="A140" value=" - Endometrioid stromal sarcoma, low-grade"><label class="choice">Endometrioid stromal sarcoma, low-grade</label>
<input class="element checkbox" type="checkbox" id="A141" value=" - Endometrioid stromal sarcoma, high-grade"><label class="choice">Endometrioid stromal sarcoma, high-grade</label>